Title Page

  • Site conducted

  • Conducted on

  • Machine Model

  • Machine Serial Number

  • Machine Serial Number (If not listed in previous question)

  • Prepared by

  • Location

  • Purpose of Site Visit / Work Completed / General Comments

  • Was a service carried out?

  • What level of service was completed?

  • If other is highlighted above please specify

  • Engineer(s) on Site

  • Pictures of machine:

  • Engine Hours:

  • Application:

  • Material Type:

  • Picture of Material Type:

  • Are you reporting information on a crusher?

  • Crushing Hours:

  • Crusher Speed:

  • Crusher CSS/Apron settings:

  • Liner/Blowbar Spec:

  • Max Feed Size:

  • Prescreen/Feeder media:

  • Recirc Media:

  • Crusher Output:

  • Picture of machine Output:

Summary of Issues/Areas for Improvement

  • Issues/Areas for Improvement for:

  • Image of issue

  • Description of issue

  • Do you want to add more issues/areas for improvement?

  • Issues/Areas for Improvement for:

  • Image of issue

  • Description of issue

  • Do you want to add more issues/areas for improvement?

  • Issues/Areas for Improvement for:

  • Image of issue

  • Description of issue

  • Do you want to add more issues/areas for improvement?

  • Issues/Areas for Improvement for:

  • Image of issue

  • Description of issue

  • Do you want to add more issues/areas for improvement?

  • Issues/Areas for Improvement for:

  • Image of issue

  • Description of issue

  • Do you want to add more issues/areas for improvement?

  • Issues/Areas for Improvement for:

  • Image of issue

  • Description of issue

  • Do you want to add more issues/areas for improvement?

  • Issues/Areas for Improvement for:

  • Image of issue

  • Description of issue

  • Do you want to add more issues/areas for improvement?

  • Issues/Areas for Improvement for:

  • Image of issue

  • Description of issue

  • Do you want to add more issues/areas for improvement?

  • Issues/Areas for Improvement for:

  • Image of issue

  • Description of issue

  • Do you want to add more issues/areas for improvement?

  • Issues/Areas for Improvement for:

  • Image of issue

  • Description of issue

Parts

  • Parts used:

  • Parts required:

  • Engineer Signature:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.